SSRI use tied to small increase in diabetes risk among children and adolescents

Children and adolescents initiating selective serotonin reuptake inhibitor (SSRI) treatment may have a small increase in risk of developing type 2 diabetes mellitus (T2DM), particularly among publicly insured patients, results of a recent study have shown.

“The magnitude of association [between SSRI treatment and T2DM among children and adolescents] was more modest than previously reported, and the absolute risk was small. Nonetheless, the potential small increase in risk should be viewed in relation to the efficacy of SSRIs for their major indications in young patients,” concluded the researchers. [JAMA Psychiatry 2020, doi:10.1001/jamapsychiatry.2020.2762]

In the retrospective cohort study, data of 1,582,914 patients (female, 58.3 percent; mean age, 15.1 years) with a diagnosis indicated for initiating SSRI treatment were extracted from two US nationwide health care databases, namely the Medicaid Analytic eXtract (MAX, from 1 January 2000 to 31 December 2014) consisting of privately insured patients, and the IBM MarketScan (1 January 2003 to 30 September 2015) consisting of privately insured patients.

There were 316,178 patients (female, 62.2 percent; mean age, 14.7 years) in the MAX database and 211,460 patients (female, 63.9 percent; mean age, 15.8 years) in the MarketScan database who had ≥2 SSRI prescriptions filled. These patients were followed up for a mean duration of 2.3 years and 2.2 years, respectively.

Among publicly insured patients, initiation of SSRI treatment was associated with a 13 percent increase in risk of T2DM (intention-to-treat [ITT] adjusted hazard ratio [aHR], 1.13; 95 percent confidence interval [Cl], 1.04 to 1.22) compared with those without treatment, following multi-covariate adjustment. The association was stronger for continuous SSRI treatment (aHR, 1.33; 95 percent Cl, 1.21 to 1.47), corresponding to 6.6 additional T2DM cases per 10,000 patients treated for >2 years.

The magnitude of association between SSRI treatment and T2DM was, however, smaller among privately insured patients (ITT aHR, 1.01; 95 percent CI, 0.84 to 1.23) (as-treated aHR, 1.10; 95 percent CI, 0.88 to 1.36).

SSRI treatment vs psychotherapy was associated with a 1.44-fold and 1.21-fold increase in risk of T2DM in publicly insured patients and privately insured patients, respectively.

In contrast, there was no significant increase in hazard when SSRI treatment was compared with bupropion treatment (publicly insured as-treated aHR, 1.01; 95 percent CI, 0.79 to 1.29) (privately insured as-treated aHR, 0.87; 95 percent CI, 0.44 to 1.70). Within-class analysis revealed comparable aHRs compared with fluoxetine.